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140 Cards in this Set
- Front
- Back
Baby presents with cyanosis (blue)
5 common causes? what is the underlying pathology? |
5 T's
1. Tetralogy of Fallot (most common) 2. Transposition of great vessels 3. Truncus arteriosus 4. Tricuspid atresia 5. Total anomalous pulmonary venous return R-L shunt |
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What is persistent truncus arteriosus and what does it cause?
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failure of truncus arteriosus to divide into pulmonary trunk and aorta
causes early cyanosis |
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What is tricuspid atresia and what does it cause?
what MUST be present for surviival |
absence of tricuspid valve --> loss of connection between RA and RV --> hypoplastic RV --> early cyanosis
ASD and VSD |
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What is total anomalous pulmonary venous return (TAPVR) and what does it cause
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pulmonary vein drains into right heart circulation
causes early cyanosis |
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What are 3 common causes of late cyanosis (blue kids) and what are their relative frequencies?
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Left-->Right shunt
VSD > ASD > PDA |
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what is the most common congenital cardiac anomaly and what does it cause
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VSD --> late cyanosis
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A kid presents with cyanosis, loud S1, and a wide, fixed split S2
dx? |
ASD
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Patent ductus arteriosus
what can it cause? how do you treat? |
late cyanosis (blue kids)
close with indomethacin |
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What is Eisenmenger's syndrome
pathway? what can this cause? |
When a L-->R shunt switches to R --> L
Uncorrected VSD/ASD/PDA --> pulmonary vascular hypertrophy --> pulmonary HTN --> incraseases pulmonary resistance, causes reversal of shunt late cyanosis (clubbing and polycythemia) |
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4 heart abnormalities in tetralogy of fallot?
How can patients improve the symptoms and why? |
SQUAT to imPROVe the symptoms
Pulmonary stenosis RV Hypertertrophy Overriding aorta VSD Squat --> compress femoral arteries --> increase TPR --> reduces R to L shunt, more blood directed from RV to lungs |
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Patient is a child that experienced early cyanosis
on x-ray, see a boot shaped heart, indicating Right ventricular hypertrophy patient suffers 'cyanotic spells', or acute hypoxic events in which syncope occurs; squatting helps with these symptoms dx? cause? |
Tetralogy of fallot
caused by anterosuperior displacement of the infundibular septum |
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Transposition of great vessels
Defect? Cause? Course? |
Aorta leaves RV, PA leaves LV (switched)
caused by failure of aorticopulmonary septum to spiral Must use surgery to present VSD/PDA/patent foramen ovale or death occurs in first few months |
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How does infantile coarctation of the aorta differ from adult type
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infantile = coarctation is preductal (ductus arteriosu)
adult = coarctation is psostductal (distal to ligamentum arteriosum) INfantile: IN close to the heart aDult = Distal to Ductus |
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Adult comes in with notched ribs, HTN in upper extremities, weak pulses in lower extremities
Heart sounds - diastolic murmur that makes a blowing sound dx? |
Adult type coarctation of the aorta
Aortic regurgitation sound caused by bicuspid aortic valve |
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What condition is associated with high incidence of infantile coarctation of the aorta
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Turner's
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How does a patent ductus arteriosus change in fetal period to a neonate
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Fetal = R--> L shunt (normal
Neonate = L--> R shunt (abnormal, due to decreased lung resistance) --> RV hypertrophy, failure |
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Patient has a 'machine like murmur' that is constant
dx? what can happen if this goes uncorrected? |
PDA
can cause cyanosis in lower extremities (differential cyanosis) |
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PDA
what keeps it open? why would you want to do that? what closes it? |
pgEE (prostaglandins) kEEps it open
may be necessary to sustain life if you have a condition like transposition of great vessels Indomethacin closes it (NSAID) |
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One drug that closes PDA
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indoemethacin
ENDomethacin ENDS PDA |
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Congenital cardiac defects associated with...
2 defects associated with 22q11 |
Truncus arteriosus, Tetralogy of Fallot
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Congenital cardiac defects associated with...
Down Syndrome (3) |
ASD
VSD AV septal defect (endocardial cushion defect) |
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Congenital cardiac defects associated with...
Congenital rubella (3) |
Septal defect
PDA PA stenosis |
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Congenital cardiac defects associated with...
Turner Syndrome |
Coarctation of aorta (preductal)
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Congenital cardiac defects associated with...
Marfan's |
Aortic insufficiency (late complication)
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Congenital cardiac defects associated with...
Infant of diabetic mother |
Transposition of great vessels
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HTN
definition? risk factors? |
BP > or = 140/90
age, obesity, diabetes, smoking, genetics, black>white>asian |
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HTN
1. most common cause 2. 2nd most common cause |
1. primary/essential, related to high CO or TPR
2. Renal disease |
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HTN
what is malignant HTN |
Severe and rapidly progressing HTN
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Atherosclerosis
LV hypertrophy Stroke CHF Renal failure Retinopathy Aortic dissection These are all associated with what general condition |
HTN
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Hyperlipidemia signs
what are atheromas |
plaques in blood vessel walls
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Hyperlipidemia signs
what are xanthomas? xanthelesma? |
plaques/nodules of lipid-laden histiocytes in skin
xanthoma of eyelids |
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Hyperlipidemia signs
what is a tendinous xanthoma |
lipid deposited in tendon, esp. achilles
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Hyperlipidemia signs
what is a corneal arcus |
lipid deposit in cornea, non specific (arcus senilis)
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Monckeberg Arteriorsclerosis
a. what happens b. where c. what does it cause |
a. calcification in media of arteries
b. often in radial or ulnar arteries c. usually benign, does not block flow; causes 'pipestream arteries' |
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Arteriosclerosis
a. what is it b. associated conditions c. what can you see with malignant HTN? |
a. hyaline thickening of small arteries
b. associated in essential HTN or diabetes c. see hyperplastic onion skinning |
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What is atherosclerosis?
what types of arteries? |
fibrous plaques on intima of arteries
elastic arteries, large and medium sized muscular arteries |
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Smoking, HTN, diabetes, hyperlipidemia, family hx
predispose to what |
atherosclerosis
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Progression of atherosclerosis, from endothelial cell dysfunction to complex atheromas
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endothelial dysufnction --> inflammation, accumulation of macrophages and LDL --> foam cells (macrophages full of LDL) --> fatty streaks --> smooth muscle migration into intima (PDGF, TGF) --> fibrous plaque --> complex atheroma
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Aneurysms
Ischemia Infarcts Peripheral vascular disease Thrombus Emboli complications of what |
atherosclerosis
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4 common locations for atherosclerosis
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abdominal aorta > coronary artery > popliteal artery > carotid artery
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What are 2 possible symptoms of
atherosclerosis |
angina
claudication |
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Patient with HTN presents with tearing chest pain that radiates to the back
CXR shows mediastinal widening MRI shows false lumen occupying most of the descending aorta dx? what has happened? 2 associated conditions? What is the course? |
aortic dissection
longitudinal intraluminal tear --> false lumen HTN or cystic medial necrosis (marfan's) may result in aortic rupture, death |
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Ischemic heart disease
what is it called when the coronoary artery is narrowed by >75% |
angina
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Ischemic heart disease
Patient has retrosternal chest pain WITH EXERTION, goes away at rest, ST depression dx? Secondary to...? |
stable angina, usually secondary to atherosclerosis
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Patient has chest pain at rest that comes on in cycles, often at night
-exercise stable -ST elevation on ECG dx? secondary to what? |
Prinzmetal's angina
Secondary to coronary artery spasm |
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Ischemic heart disease
Patient complains of chest pain at rest, that seems to get worse and worse ST depression dx? cause? |
Unstable/crescendo angina
thrombosis but no necrosis |
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MI
what is the most common cause? What does it lead to? |
acute thrombosis due to coronary artery atherosclerosis
leads to myocyte necrosis |
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Patient experiences acute chest pain, and 1 hour later is dead
what is this called? most common cause? |
sudden cardiac death
deadly arrhythmia |
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What is chronic ischemic heart disease
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Progressive onset of CHF over many years due to chronic ischemic myocardial damage
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What coronary arteries are most often occluded?
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LAD > RCA > circumflex
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Patient presents to the ER with
-diaphoresis -nausea -vomiting -severe retrosternal pain -pain in left arm/jaw -shortness of breath -fatigue -adrenergic symptoms what's going on |
MI
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When after an MI is there risk of an arrhythmia
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Within first 4 days
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When after an MI is there risk for free wall rupture, tamponade, papillary muscle rupture, or interventricular septal rupture
why is this risk heightened at this time |
5-10 days after
macrophages have degraded important structural components |
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When after an MI is there increased risk for a ventricular aneurysm
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7 weeks
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Evolution of an MI
a. what can you see in the first 2-4 hours b. what can you start to see after 4 hours c. what shows up after 12-24 hours |
a. No change by light microscopy
b. early coagulative necrosis, release of necrotic cells into bloodstream, start of neutrophil emigration c. contraction bands visible |
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On the first day of an MI, what would you see from the infarcted area if you stained it with tetrazolium stain
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Tissue would be pale
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Evolution of an MI
-Tissue surrounding infarct shows acute inflammation -hyperemia (dilation) -PMN emigration -muscle shows coagulative necrosis how long after the MI |
2-4 days
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Evolution of an MI
Tissue has a hyperemic border with a central yellow-brown softening outer zone of granulation tissue how long has it been since the MI? |
5-10 days
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Evolution of an MI
Tissue is gray/white, artery is recanalized, contracted scar is complete how long since MI |
7 weeks
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After an MI, when is the tissue maximally yellow and soft
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10 days
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Diagnosis of MI
Gold standard of diagnosis within first 6 hours |
ECG
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Diagnosis of MI
What can you look for after 4 hours that is more specific than other protein markers how long does it last |
troponin I rises after 4 hours, elevated for 7-10 days
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Diagnosis of MI
how do you diagnose reinfarction on top of acute MI where is it found |
Ck-MB
myocardium and skeletal muscle |
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Diagnosis of MI
A nonspecific protein that can be fond in cardiac, liver, and skeletal muscle cels |
AST
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Diagnosis of MI - where was the infarct if on ECG you see
a. ST elevation b. ST depression c. Pathologic Q waves |
a. transmural
b. subendocardial c. transmural |
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Transmural infarct vs. Subendocardial infarct
amount of necrosis |
T = full wall thickness
SE = ischemic necrosis of <50% of wall, subendocardium vulnerable due to fewer collaterals and higher pressure |
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Transmural infarct vs. Subendocardial infarct
ECG findings |
T = ST elevation, Q waves
SE = ST depression |
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ECG diagnosis of MI
If V1-V4 have Q waves, where is the infarct |
Anterior wall (LAD)
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ECG diagnosis of MI
If V1-V2 have Q waves, where is the infarct |
Anteroseptal (LAD)
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ECG diagnosis of MI
If V4-V6 have Q waves, where is the infarct |
Anterolateral (LCX)
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ECG diagnosis of MI
If ledes I and aVL have Q waves, where is the infarct |
lateral wall (LCX)
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ECG diagnosis of MI
If ledes II, III, and aVF have Q waves, where is the infarct |
Inferior wall (RCA)
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MI complications
One important complication often seen in first few days, common cause of death before reaching hospital |
arrhythmia
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MI complications
What is cardiogenic shock |
Ventricles fail to pump enough blood to body after MI
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MI complications - what is the result of
a. ventricular free wall rupture b. papillary muscle rupture c. interventricular septal rupture |
a. Cardiac tamponade
b. Mitral regurg c. VSD |
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MI complications
3 risks of a post-MI aneurysm |
1. decrease CO
2. risk of arrhythmia 3. embolus from mural thrombus |
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MI complications
3-5 days after an MI, you hear a friction rub What could be going wrong |
Postinfarction fibrinous pericarditis
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MI complications
Several weeks post-MI, you get fibrinous pericarditis dx? |
Dressler's syndrome = autoimmune phenomenon resulting in fibrinous pericarditis
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Cardiomyopathies
what is the most common cardiomyopathy? |
Dilated (congestive)
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Alcohol abuse
wet Beriberi Coxsackie B virus myocarditis Chronic cocaine use Chagas' Doxorubicin toxicity Hemochromatosis Peripartum cardiomyopathy Common etiologies of what condition |
dilated cardiomyopathy
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On chest exam, you hear an S3
-see dilated heart on ultrasound -CXR reveals balloon appearance of heart dx? What is the pathogenesis? |
dilated cardiomyopathy
Ventricluar dysfunction --> hypertrophy of ventricular wall myocardium (sarcomeres added in series, eccentric) --> systolic dysfunction |
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Common cause of sudden death in young athletes
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hypertrophic cardiomyopathy
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dilated vs. hypertrophic cardiomyopathy
type of hypertrophy? |
dilated = eccentric hypertrophy, sarcomeres added in series
hypertrphic = concentric hypertrophy, sarcomeres added in parallel |
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Patient with a syncopal episode comes in to clinic. You see...
-has a normal sized heart -S4 -Apical impulses -Systolic murmur dx? treat? |
Hypertrophic cardiomyopathy
B-blocker or non-dihydropyridine Ca channel blocker |
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Dilated vs. hypertrophic cardiomyopathy
what type of dysfunction ensues |
dilated --> systolic dysfunction
hypertrophic --> diastolic dysfunction |
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Hypertrophic cardiomyopathy
what is the actual defect in the heart that syncope and systolic murmur' what would you see histologically? |
Hypertrophied interventricular septum and mitral valve leaflet are so close that they obstruct the outflow tract
Also see disoriented, hypertorphied myocardial fibers |
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Hypertrophic cardiomyopathy
a. % of cases due to genetic causes, and what is the cause b. associated with what neurological condition |
a. 50% familial, autosomal dominant
b. Friedreich's ataxia |
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-Sarcoidosis
-amyloidosis -post-radiation fibrosis -endocardial fibroelastosis (fibroelastic tissue in endocardium of young kids) -Loffler's syndrome (endomyocardial fibrosis wih a prominent eosinophilic infiltrate) -hemochromatosis (dilated cardiomyopathy can also occur) all major causes of what? what type of dysfunction ensues? |
restrictive/obliterative cardiomyopathy
diastolic dysfunction ensues |
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CHF
Abnormality = dyspnea on exertion What is the cause |
Failure of LV to pump output to increase during exercise
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CHF
Abnormality = y dilation What is the cause |
Greater ventricular end-diastolic volume
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CHF
Abnormality = Pulmonary edema, paroxysmal nocturnal dyspnea, heart failure cells What is the cause what key thing would you see histologically and what caused them? |
LV failure --> increased pulmonary venous pressure ---> pulmonary venous distention, transudate
heart failure cells = hemosiderin-laden macrophages in lungs due to microhemorrhages from increased pulmonary capillary pressure |
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CHF
Abnormality = orthopnea (SOB when supine) What is the cause |
increased venous return when supine exacerbates pulmonary vascular congestion
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CHF
Abnormality = Hepatomegaly (nutmeg liver) What is the cause |
increased central venous pressure --> increased resistance to portal blood flow
rarely leads to cardiac cirrhosis |
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CHF
Abnormality = Ankle, sacral edema What is the cause |
RV failure --> increased venous pressure --> transudation
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CHF
Abnormality = JVD What is the cause |
RH failure --> increased venous pressure
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CHF
Abnormality = RHF What is the cause |
most often caused by LHF
isolated --> result of cor pulmonale |
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-fever
-Roth's spots -Osler's nodes -new Murmur -Janeway lesions -anemia -Nail bed splinter hemorrhage -Embolus consider what diagnosis |
bacterial endocarditis
FROM JANE |
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bacterial endocarditis - what are these called
Round white spots on retina surrounded by hemorrhage |
Roth's spots
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bacterial endocarditis - what are these called
Tender raised lesions on finger or toe pads |
Osler's nodes
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bacterial endocarditis - what are these called
Small erythematous lesions on palm or sole |
Janeway lesion
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In bacterial endocarditis, what may be causing the new heart murmur
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damaged aortic valve
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Common cause of acute bacterial endocarditis
where do you see vegetations how is the onset |
s. aureus
large vegatations on previously healthy valves rapid onset |
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Common cause of subacute bacterial endocarditis
where do you see vegatations where do you get it from speed of onset |
viridans strep
smaller vegetations on congenitally abnormal or diseased valves from dental procedures insidious |
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2 causes of nonbacterial endocarditis
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Malignancy
Hypercoagulable state (marantic/thrombotic endocarditis) |
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bacterial endocarditis
Bacteria associated with this condition in a patient with colon cancer |
S. bovis
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bacterial endocarditis
type of bacteria seen on prosthetic valves |
s. epidermidis
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Type of bacteria that cause culture-negative bacterial endocarditis
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HACEK
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bacterial endocarditis
Most frequent valve involved |
mitral
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bacterial endocarditis
What valve is implicated in IVDU 3 associated bugs? |
TRIcuspid valve (don't TRI drugs)
S. aureus, Pseudomonas, Candida |
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Chordae rupture
Glomerulonephritis Suppurative pericarditis Emboli Complications of what condition? |
bacterial endocarditis
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Type of endocarditis caused by SLE
where are the vegetations and how big are they associated with what conditions |
Liban-Sacks endocarditis
(SLE causes LSE) Small, sterile vegetations on both sides of the valve Associated with mitral regurgitation, sometimes mitral stenosis |
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Patient presents with
-Fever -Erythema marginatum -Valvular damage (vegetation and fibrosis) -ESR increased -Red hot joints (migratory polyarthritis) -Subcutaneous nodules -St. Vitus' dance (chorea) dx? |
Rheumatic Fever secondary to GABHS infection
FEVERSS |
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On biopsy of heart tissue, you see
-aschoff bodies (granuloma with giant cells) -Anitschkow's cells (activated histiocytes) -elevated ASO titers dx? |
Rheumatic heart disease
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What causes Rheumatic heart disease
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type II hypersensitivity (immune mediated)
Igs made to M protein of GABHS, attack heart, kidney, etc. |
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Rheumatic fever
a. early sequelae involving heart b. late sequelae - which valves most affected |
a. death due to myocarditis
b. rheumatic heart disease -high pressure valves: Mitral > aortic >> tricuspid |
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Rheumatic heart disease
a. early lesion b. late lesion |
a. mitral valve prolapse
b. mitral stenosis |
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What is the condition in which the heart is compressed by fluid (blood, effusions) in the pericardium, leading to decreased CO
what does this condition do to diastolic pressures |
cardiac tamponade
equilibriates diastolic pressures in all 4 heart chambers |
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Patient has:
-hypotension -JVD (venous pressure increased) -distant heart sounds -increased HR -pulsus paradoxus (exaggerated decrease in amplitude of pulse in inspiration) dx? |
Cardiac tamponade
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5 conditions in which you see pulsus paradoxus
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1. cardiac tamponade
2. asthma 3. obstructive sleep apnea 4. pericarditis 5. croup |
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Patient comes in with
-hemoptysis -hematuria -perforation of nasal septum -chronic sinusitis -otitis media -mastoiditis -cough -dyspnea CXR reveals large nodular densities dx? What is the triad associated with this? treat? |
Wegner's granulomatosis (small vessels)
1. necrotizing vasculitis 2. necrotizing granulomas in lung and upper airway 3. necrotizing glomerulonephritis Cyclophosphamide and corticosteroids |
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What is a small vessel vasculitides that has necrotizing vasculitis and glomerulnephritis, but lacks the granulomas of Wegner's
also is pANCA positive |
Microscopic polyangiitis
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What is one vasculitis limited to the kidney that lacks antibody response
|
primary pauci-immune crescentic glomerulonephritis
PAUCI-immune = PAUCIty of antibodies |
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Patient presents with
-Asthma -Sinusitis -Skin lesions -Peripheral neuropathy (wrist/foot drop) -may also see pathology on heart, GI, kidneys see p-ANCA dx? What would you see on biopsy |
Churg Strauss
See granulomatous vasculitis with eosinophilia |
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Patient presents with
-nevus flammeus (port-wine stain on face) -ipsilateral leptomeningeal angiomatosis (intracerebral AVM) -seizures -early onset glaucoma dx? what does it affect? How do you get it |
Sturge-Weber Disease
Affects capilary-sized blood vessels Congenital |
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What is the most common form of childhood systemic vasculitis
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Henoch Schonlein purpura
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Patient is a child who presents following a URI with
-palpable purpura on butt and legs (rash) -Arthralgia -Severe abdominal pain -melena dx? What antibodies would you expect to find? What is one disease association? |
Henoch-Schonlein purpura
IgA immune complexes deposited on small vessels Associated with IgA nephropathy |
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Patient is a heavy smoker, presents with
-intermittent claudication -superficial nodular phlebitis -cold sensitivity (raynaud's phenomenon) -severe pain peripherally dx? path? course? |
Buerger's disease
Idiopathic, spontaneous thrombosing of small and medium peripheral arteries and veins May lead to gangrene and autoamputation of digits if patient doesn't stop smoking |
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ASIAN child gets
-fever -conjunctivitis -lymphadenitis -changes in lips and oral mucosa -desquamative skin rash dx? path? Treat? |
Kawasaki disease
Necrotizing vasculitis in small or medium vessels, found in kids, esp. Asians Treat with IV immunoglobulin and aspirin |
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Patient presents with
-fever, wt. loss, malaise, abdominal pain, melena, headache, myalgia, HTN, neuro dysfunction, cutaneous eruptions (different ages) -Arteriogram reveals multiple aneurysms and constrictions -Hep B seropositive (30%) dx? What would you see on histo? Where does this disease affect? treat? |
Polyarteritis nodosa
IC-mediated transmural vasculitis with fibrinoid necrosis Affects small and medium renal and visceral vessels; not pulmonary arteries treat with corticosteroids, cyclophosphamide |
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Patient is an Asian female <40, presents with
-Fever -Arthritis -Night sweats -MYalgia -SKIN nodules -Ocular disturbances -Weak pulse in upper extremities -Tests reveal elevated ESR dx? what would you see on histo? |
Takayasu's arteritis
granulomatous thickening of aortic arch and/or proximal great vessels Symptom mnemonic: FAN MY SKIN On Wednesday |
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Elderly female presents with
-unilateral headache -jaw claudication -impaired vision (occlusion of ophthalmic artery can lead to irreversible blindiness) -Find elevated ESR -Half of patients have systemic involvement and polymyalgia rheumatica dx? What would you see on biopsy? treat? |
Temporal (giant cell) arteritis
Branches of carotid (medium and large arteries) show focal, granulomatous inflammation High dose steroids "TEMPoral arteritis affects the TEMPles" |
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Vascular tumors
A benign capillary hemangioma of infancy that initially grows with the child, but spontaneously regresses |
Strawberry hemagioma
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Vascular tumors
Benign capillary hemangioma of elderly that does not regress, increases with age |
Cherry hemangioma
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Vascular tumors
Polyoid capillary hemangioma in oral/nasal that can ulcerate and bleed, associated with trauma and pregnancy |
pyogenic granuloma
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Vascular tumors
Cavernous lymphagioma of neck, associated with Turners |
Cystic hygroma
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Vascular tumors
Benign, painful, red-blue tumor under fingernails that arises from modified smooth muscle cells of the glomus body |
Glomus tumor
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Vascular tumors
Benign capillary skin papules found in AIDS patiens, often mistaken for kaposi's what is the bacteria |
bacillary angiomatosis
bartonella henselae infection |
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Vascular tumors
Lethal malignancy of liver, associated with vinyl chloride, arsenic, and ThO2 (thorotrast) exposure |
Angiosarcoma
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Vascular tumors
Lymphatic malignancy associated with persistent lymphedema (eg. Post-radical mastectomy) |
Lymphangiosarcoma
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Vascular tumors
Endothelial malignancy of the skin associated with HHV-8 and HIV Mistaken for bacillary angiomatosis often |
kaposi's sarcoma
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